9. Anal fistula / Anal abscess
There are secretion producing glands whıch are called proctodeal glands
between interior and exterior
(closing) muscles. If they inflammated, the secretion can't drain off and
tries to open a channel between the muscles towards the skin. Since it
cannot break through the skin, it accumulates as pus and becomes a painful
abscess. If this pus accumulation is not discharged, it propagates and even
starts damaging the surrounding tissues.
If the pus can be discharged, the inflammation calms down quickly. However,
a connecting link between the anal channel and the skin may be remain over
as a tiny canal, which is called an anal fistula. This tiny canal is lined
with a special lining (epithelium), whereby it cannot heal itself off.
Depending upon the direction it takes, there are many different types of
fistula, which most common types are the ones between the interior and
Obstruction of the proctodeal glands by stool
Infections from other body parts
Anal diseases like hemorrhoids or fissures
Injuries of the intestinal mucosa and anal skin
Inflamed bowel diseases like Morbus Crohn or Colitis
Patient feels painfull swelling during abscess formation as well as general
symptoms such as fever, weakness and urination problems. In the case of
fistula, a small skin opening can be visible around the anus area. The
secretion causes wetness and skin irritation . It is uncommon to experience
any severe pain. The fistula can exist in such a way over a long period,
sometimes years, and shows no tendency for self-healing. Although rarely,
changes into malignity can occur in process of time.
It is necessary to widen the area in order to drain the abscess. After this
operation, effected areas would self-heal in a few weeks.
In the case of fistula, it has to be treatened surgically. Nevertheless it
shows a high reccurency. Injuries of sfincter (closing) muscles can cause to
the disruption of the sealing function of the closing muscles.
As an alternative to the operation, a thread may be inserted in the fistula.
This method is very lengthy processes and may not be as successful.
In our clinic superficial fistula tracts will be
opened completely by the diod laser (laser fistulotomy). In case of deeper
fistulas, only the outer part of the fistula will be removed as an open
procedure. A special round bodied drill is then inserted into the inner
muscle part to clean it from the inside. Finally the fistula is sealed by a
diod laser. The remaining internal fistula opening will be closed by a
mucosa plastic. When this technique is used, the fistula neither needs to
be split, so the malfunction of the closing muscles (incontinence, often
scared complication) does not happen any longer.
Prior to operation, the position of the fistula can be determined
radiologicaly by Fistulography, MR Tomography or with the Endoultrasound.
These methods might be necessary in the event of suspicion on an unusual
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diseases - still a topic with taboo |
of the final intestine |
Hemorrhoids actually? |
the illness of the hemorrhoids developed?
How does the hemorrhoidal illness express itself? |
Hemorrhoids are treated? |
How is the treatment in the Proktoklinik? |
Illness of the Linea Dentata |
folds (Mariscs) |